Spray reduces pain in children undergoing intravenous procedures

A topical spray reduced pain by 34% in children undergoing intravenous procedures, such as injections and tube insertions (cannulation), compared with a placebo group. The findings from this double-blind, randomized controlled trial have clinical implications, write the researchers.

"The vapocoolant spray that we used provided quick and effective reduction of pain due to intravenous cannulation without delaying the procedure," state Dr. William Splinter and colleagues. "This feature is especially important when time is limited, such as in a busy office practice or emergency department, where topical methods of pain relief have not traditionally been available."

As well, successful insertion of a needle or tube was more frequent after using the vapocoolant spray. "Effective pain relief combined with improved success on first cannulation attempt results in fewer repeat attempts, decreased procedure times and improved satisfaction among children, parents and health care providers."

The spray is non-toxic, less expensive than alternatives, works immediately and does not require a needle.

The study looked at 80 children aged 6-12 who required urgent intravenous procedures within 30-45 minutes at the Children's Hospital of Eastern Ottawa. Outcome measurement of the vapocoolant spray was based on children's self-reported pain, the success rate on first attempt and assessments by parents and child life specialists and ease of procedure's insertion according to nurses.

Results are significant as "prior studies of vapocoolant sprays did not show a reduction in pain due to intravenous cannulation in children."

In a related commentary, Dr. K.J.S. Anand of University of Arkansas for Medical Sciences (Andrea Peel, tel: 501-686-8996 or 501-351-7903, PeelAndreaL@uams.edu for Dr. Anand) states that the results of two randomized controlled trials published in CMAJ will "likely alter clinical practice and stimulate further research into the use of currently available nonpharmacologic analgesic in children".

"Indeed, these authors are to be commended for their innovative study designs, implementation, statistical analyses and data interpretation, which bring the highest standards of evidence-based medicine to the field of pediatric pain research."

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